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NPI Code Detail

MEDICARE: MACK WILLIS WHITE III MD

MEDICARE: MACK WILLIS WHITE III MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician24623NC

General Provider Information

NPI Number : 1760401400
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACK WILLIS WHITE III MD
Provider Business Mailing Address
First Line : PO BOX 19305
Second Line :
City : CHARLOTTE
State : NC
Zip : 28219-9305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7030 PINEVILLE MATTHEWS RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-8298
Country : US
Telephone Number : 704-667-4150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 05/04/2023

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